DKA Fluids Calculator

Patient Name:
Patient Weight:	kgs lbs
Insulin Dose:	units/kg/h
Rehydration Rate:	mL/hr X maintenance
Maintenance:	mL/h

Table 1. Use with D10%
Row	Glucose : Insulin Ratio (g : unit)	Insulin* Rate (mL/h)	Rate of fluid WITHOUT Dextrose (mL/h)	Rate of fluid WITH 10% Dextrose (mL/h)	Total Fluid Rate (mL/h)	Effective Dextrose Concentration (%)

Table 2. Use with D12.5%

Row Glucose : Insulin
Ratio
(g : unit) Insulin* Rate
(mL/h) Rate of fluid
WITHOUT
Dextrose
(mL/h) Rate of fluid
WITH
12.5% Dextrose
(mL/h) Total
Fluid Rate
(mL/h) Effective
Dextrose
Concentration
(%)

Instructions

Hover mouse cursor over blue text to see tool tips.

Enter Patient Weight and click on the Calculate button. The default insulin dose is 0.1 units/kg/h.
Leave Rehydration Rate blank and the calculator will replace it with the value of maintenance x2.
Consider using the Dehydration Correction Calculator to calculate Rehydration Rate.

After the initial fluid bolus, recheck blood glucose, and start fluids with Row 0.

If the blood glucose Rate of Fall is > 100 mg/dL per hour, go to the next Row.
If the blood glucose Rate of Fall is < 50 mg/dL per hour, go to the previous Row.

When the blood glucose falls below the 300 mg/dL upper Range limit, go to Row 3.
If the blood glucose falls below the 200 mg/dL lower Range limit, go to the next Row.
If the blood glucose rises back up over 300 mg/dL, go to the previous Row (or in between).
If the blood glucose continues to fall despite being at the highest glucose:insulin ratio (Row 6),
   change to D12.5 and use Table 2, starting at a higher effective dextrose concentration.



Target Range: 200-300 mg/dL blood glucose

Target Rate of Fall: 50-100 mg/dL per hour


If the maximal achievable glucose:insulin ratio is insufficient with the current parameters,
increase the total fluid rate before decreasing the insulin rate


The 2018 ISPAD Clinical Practice Guidelines for Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State.
The rationale for this updated algorithm is explained in this presentation.

Disclaimer: All calculations must be confirmed.

Created: August 9, 2021 Revised: September 9, 2022

© 2021, 2022 Weill Cornell Medical College

Table 2. Use with D12.5%
Row	Glucose : Insulin Ratio (g : unit)	Insulin* Rate (mL/h)	Rate of fluid WITHOUT Dextrose (mL/h)	Rate of fluid WITH 12.5% Dextrose (mL/h)	Total Fluid Rate (mL/h)	Effective Dextrose Concentration (%)

	Instructions
Hover mouse cursor over blue text to see tool tips. Enter Patient Weight and click on the Calculate button. The default insulin dose is 0.1 units/kg/h. Leave Rehydration Rate blank and the calculator will replace it with the value of maintenance x2. Consider using the Dehydration Correction Calculator to calculate Rehydration Rate. After the initial fluid bolus, recheck blood glucose, and start fluids with Row 0. If the blood glucose Rate of Fall is > 100 mg/dL per hour, go to the next Row. If the blood glucose Rate of Fall is < 50 mg/dL per hour, go to the previous Row. When the blood glucose falls below the 300 mg/dL upper Range limit, go to Row 3. If the blood glucose falls below the 200 mg/dL lower Range limit, go to the next Row. If the blood glucose rises back up over 300 mg/dL, go to the previous Row (or in between). If the blood glucose continues to fall despite being at the highest glucose:insulin ratio (Row 6), change to D12.5 and use Table 2, starting at a higher effective dextrose concentration.
	Target Range: 200-300 mg/dL blood glucose Target Rate of Fall: 50-100 mg/dL per hour
	If the maximal achievable glucose:insulin ratio is insufficient with the current parameters, increase the total fluid rate before decreasing the insulin rate
	The 2018 ISPAD Clinical Practice Guidelines for Diabetic Ketoacidosis and the Hyperglycemic Hyperosmolar State. The rationale for this updated algorithm is explained in this presentation.

Disclaimer: All calculations must be confirmed.
Created: August 9, 2021	Revised: September 9, 2022
© 2021, 2022 Weill Cornell Medical College